Dermatology and Urology: United by the Androgen Receptor

The Benefits of Urology Research

At first glance, it would seem that the medical specialists of Urology and Dermatology and quite different.  One deals with the physiology and functioning of the urinary system and the other deals with the dermatological system which comprises skin, hair and nails. The two however, are much more closely linked that you might imagine. 

The Androgen Receptor

The Androgen Receptor is a protein that sits in the outer layer of cells (known as the cytoplasm). One of its jobs is to bind to androgens that diffuse into the cell and form an androgen receptor-androgen complex.  The types of androgens that bind to the androgen receptor are many but the most commonly studied ones are testosterone and dihydrotestostone. The newly formed androgen receptor-androgen complex then translocates from the cytoplasm into the deepest regions of the cell (known as the nucleus) where the complex binds to DNA and stimulates the machinery needed for the cell to make new types of proteins (called transcription and translation).

What's the connection?

The androgen receptor has an important role in many fields of medicine including Urology and Dermatology. It's very clear that aberrant signals from the androgen receptor help prostate cancer cells to grow and so an understanding of androgen receptor physiology drives much of the field of prostate cancer research. Some of the drugs that are used to treat prostate cancers are blockers of some kind of androgen receptor function. Common examples are non-steroidal anti androgens like bicalutamide, nilutamide, enzalutamide, apalutamide, and steroidal anti androgens like cyproterone acetate.

In dermatology, the androgens and the androgen receptor also has an important role. Conditions like acne, hair loss and even syndromes associated with increased hair growth can be driven by androgens. Androgenetic alopecia (male balding and female pattern hair loss) are androgen dependent to some degree and medications that block androgens are commonly used. This includes finasteride, dutasteride, spironolactone, cyproterone acetate, flutamide.

Research Research in Urology

I continue to closely follow the field of Urology. There's no doubt in my mind that advances in Urology (especially in prostate cancer research) will directly translate into benefits to dermatology.   Just this week, I was asked about the use of an experimental prostate cancer drug Darolutamide for treating male balding. Darolutamide, which is a close cousin of enzalatumide and apalutamide, is not approved for use yet even for treating prostate cancer but clearly many minds have recognized this important link between drugs in Urology and drugs that may be useful to the hair loss world. 

As yet another example of the commonality between Urology and the field of hair loss dermatology, studies continue to show that balding in the crown (vertex) in men has some link to an increased risk of prostate cancer. Clearly, there are some genes that unite the two conditions, and research into prostate cancer genes and genes for balding will continue to merge together over time. 

Conclusion

It makes good sense for any hair loss specialist to follow the latest happenings in the field of urology. Many urological diseases, especially prostate cancer, are affected by androgens and medications that block the function of androgens provide benefit to these diseases. 

REFERENCE

Liang W, et al. Possible association between androgenic alopecia and risk of prostate cancer and testicular germ cell tumor: a systematic review and meta-analysis. BMC Cancer. 2018.

Jin T, et al. Association between male pattern baldness and prostate disease: A meta-analysis. Urol Oncol. 2018.